Home treatment of COPD exacerbation selected by DECAF score: a non-inferiority, randomised controlled trial and economic evaluation

Echevarria, Carlos; Gray, Joanne; Hartley, Tom; Steer, John; Miller, Jonathan; Simpson, A. John; Gibson, Gretchen; Bourke, SC

doi:10.1136/thoraxjnl-2017-211197

Cited by 48 publications

(61 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…26 The second economic evaluation was based in the United Kingdom and showed a large mean difference in health and social costs at 90 days of 1068 euros favouring HAH, which showed non-inferiority but not superiority, with a 90% chance of cost-effectiveness. 25 Part of the reason for the differences in these economic evaluations may be due to inherent differences between these healthcare systems and to the selected model of care. The Netherlands-based study was of ESD, in which patients were randomized after 3 days of inpatient care.…”

Section: Benefit Of Domiciliary Care Programmesmentioning

confidence: 99%

“…Most studies of domiciliary care in severe acute exacerbation are those in which the patient was admitted first, and therefore aimed to reduce hospital bed days and/or readmissions. 25,[51][52][53][54] Domiciliary services should ideally include all those services which are available in hospital, such as all members of the multidisciplinary team, physiological observations, investigations (including blood tests and arterial blood gas analysis) and treatments (including controlled oxygen and intravenous fluids and antibiotics). However, few studies had HAH services that included most of the treatments available in the hospital, 24,25 and in most studies nurses from the hospital performed visits.…”

Section: Patient Eligibilitymentioning

confidence: 99%

See 1 more Smart Citation

Models of care across the continuum of exacerbations for patients with chronic obstructive pulmonary disease

Bourbeau

Echevarria

2020

Chron Respir Dis

Self Cite

View full text Add to dashboard Cite

Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with significant morbidity and mortality, and treatments require a multidisciplinary approach to address patient needs. This review considers different models of care across the continuum of exacerbations (1) chronic care and self-management interventions with the action plan, (2) domiciliary care for severe exacerbation and the impact on readmission prevention and (3) the discharge care bundle for management beyond the acute exacerbation episode. Self-management strategies include written action plans and coaching with patient and family support. Self-management interventions facilitate the delivery of good care, can reduce exacerbations associated with admission, be cost-effective and improve quality of life. Hospitalization as a complication of exacerbation is not always unavoidable. Domiciliary care has been proposed as a solution to replace part, and perhaps even all, of the patient’s in-hospital stay, and to reduce hospital bed days, readmission rates and costs; low-risk patients can be identified using risk stratification tools. A COPD discharge bundle is another potentially important approach that can be considered to improve the management of COPD exacerbations complicated by hospital admission; it comprised treatments that have demonstrated efficacy, such as smoking cessation, personalized pharmacotherapy and non-pharmacotherapy such as pulmonary rehabilitation. COPD bundles may also improve the transition of care from the hospital to the community following exacerbation and may reduce readmission rates. Future models of care should be personalized – providing patient education aiming at behaviour changes, identifying and treating co-morbidities, and including outcomes that measure quality of care rather than focusing only on readmission quantity within 30 days.

show abstract

Section: Benefit Of Domiciliary Care Programmesmentioning

confidence: 99%

Section: Patient Eligibilitymentioning

confidence: 99%

Models of care across the continuum of exacerbations for patients with chronic obstructive pulmonary disease

Bourbeau

Echevarria

2020

Chron Respir Dis

Self Cite

View full text Add to dashboard Cite

show abstract

“…In a randomised controlled trial and economic evaluation study of DECAF implementation, the low-risk patients (DECAF 0 or 1) selected by DECAF were more cost-effective than the usual care, mainly manifested in a fivefold reduction in the median of 90 days of hospitalisation. 7 The study showed that the DECAF score was easily applied at the bedside to guide treatment, and about twice as many patients were eligible compared with earlier models. 7 It was safe, clinically effective, cost-effective to use DECAF score at home in low-risk patients, and preferred by most patients.…”

Section: Discussionmentioning

confidence: 99%

“… 4 5 The Dyspnea, Eosinopenia, Consolidation, Acidemia and Atrial Fibrillation (DECAF) score is a risk stratification tool designed to predict risk of death in patients with AECOPD, 6 and can be easily applied at the bedside to guide treatment, such as hospital at home for low-risk patients. 7 The DECAF score uses indices routinely available at admission. The score includes five predictors, the strongest of which is stable state dyspnoea, measured by the extended Medical Research Council Dyspnea score ( table 1 ).…”

Section: Introductionmentioning

confidence: 99%

DECAF score as a mortality predictor for acute exacerbation of chronic obstructive pulmonary disease: a systematic review and meta-analysis

Huang

Xiong

et al. 2020

BMJ Open

View full text Add to dashboard Cite

ObjectivesThis study was conducted to assess the association between the Dyspnea, Eosinopenia, Consolidation, Acidemia and Atrial Fibrillation (DECAF) scores and the prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), to evaluate the specific predictive and prognostic value of DECAF scores and to explore the effectiveness of different cut-off values in risk stratification of patients with AECOPD.DesignSystematic review and meta-analysis.ParticipantsAdult patients diagnosed with AECOPD (over 18 years of age).Primary and secondary outcome measuresElectronic databases, including the Cochrane Library, PubMed, the Embase and the WOS, and the reference lists in related articles were searched for studies published up to September 2019. The identified studies reported the prognostic value of DECAF scores in patients with AECOPD.ResultsSeventeen studies involving 8329 participants were included in the study. Quantitative analysis demonstrated that elevated DECAF scores were associated with high mortality risk (weighted mean difference=1.87; 95% CI 1.19 to 2.56). In the accuracy analysis, DECAF scores showed good prognostic accuracy for both in-hospital and 30-day mortality (area under the receiver operating characteristic curve: 0.83 (0.79–0.86) and 0.79 (0.76–0.83), respectively). When the prognostic value was compared with that of other scoring systems, DECAF scores showed better prognostic accuracy and stable clinical values than the modified DECAF; COPD and Asthma Physiology Score; BUN, Altered mental status, Pulse and age >65; Confusion, Urea, Respiratory Rate, Blood pressure and age >65; or Acute Physiology and Chronic Health Evaluation II scores.ConclusionThe DECAF score is an effective and feasible predictor for short-term mortality. As a specific and easily scored predictor for patients with AECOPD, DECAF score is superior to other prognostic scores. The DECAF score can correctly identify most patients with AECOPD as low risk, and with the increase of cut-off value, the risk stratification of DECAF score in high-risk population increases significantly.

show abstract

“…Low-risk patients (DECAF 0–1) are considered for direct discharge from ED or formal hospital at home, while high-risk scores inform antibiotic choice among other aspects of care. 20 …”

Section: Introductionmentioning

confidence: 99%

Specialist emergency care and COPD outcomes

et al. 2018

Self Cite

View full text Add to dashboard Cite

IntroductionIn exacerbation of chronic obstructive pulmonary disease (ECOPD) requiring hospitalisation greater access to respiratory specialists improves outcome, but is not consistently delivered. The UK National Confidential Enquiry into Patient Outcome and Death 2015 enquiry showed over 25% of patients receiving acute non-invasive ventilation (NIV) for ECOPD died in hospital. On 16 June 2015 the Northumbria Specialist Emergency Care Hospital (NSECH) opened, introducing 24/7 specialty consultant on-call, direct admission from the emergency department to specialty wards and 7-day consultant review. A Respiratory Support Unit opened for patients requiring NIV. Before NSECH the NIV service included mandated training and competency assessment, 24/7 single point of access, initiation of ventilation in the emergency department, a door-to-mask time target, early titration of ventilation pressures and structured weaning. Pneumonia or hypercapnic coma complicating ECOPD have never been considered contraindications to NIV. After NSECH staff-patient ratios increased, the NIV pathway was streamlined and structured daily multidisciplinary review introduced. We compared our outcomes with historical and national data.MethodsPatients hospitalised with ECOPD between 1 January 2013 and 31 December 2016 were identified from coding, with ventilation status and radiological consolidation confirmed from records. Age, gender, admission from nursing home, consolidation, revised Charlson Index, key comorbidities, length of stay, and inpatient and 30-day mortality were captured. Outcomes pre-NSECH and post-NSECH opening were compared and independent predictors of survival identified via logistic regression.ResultsThere were 6291 cases. 24/7 specialist emergency care was a strong independent predictor of lower mortality. Length of stay reduced by 1 day, but 90-day readmission rose in both ventilated and non-ventilated patients.ConclusionProvision of 24/7 respiratory specialist emergency care improved ECOPD survival and shortened length of stay for both non-ventilated and ventilated patients. The potential implications in respect to service design and provision nationally are substantial and challenging.

show abstract

Home treatment of COPD exacerbation selected by DECAF score: a non-inferiority, randomised controlled trial and economic evaluation

Cited by 48 publications

References 32 publications

Models of care across the continuum of exacerbations for patients with chronic obstructive pulmonary disease

Models of care across the continuum of exacerbations for patients with chronic obstructive pulmonary disease

DECAF score as a mortality predictor for acute exacerbation of chronic obstructive pulmonary disease: a systematic review and meta-analysis

Specialist emergency care and COPD outcomes

Contact Info

Product

Resources

About